[Aggressive factors in the physiopathology of peptic ulcer. Recent findings]

The peptic ulcer (PU) is characterized by definite gastric cyto-secretory profiles. In case of duodenal ulcer (DU) and pre-pyloric gastric ulcer (PPGU), there is a prevalence of hyperparietalism with hyperchloridria, while in ulcer with body-fundic localization (BFGU) normo-hypoparietalism with normo-hypochloridria prevails. As well, the total peptic activity follows a superimposable course: it increases in cases of DU and PPGU, while it remains in the normal range in case of BFGU. With reference to the qualitative variations of pepsin, in course of PU the amount of pepsin 1 increases significantly. Such pepsin has a powerful proteolytic action even at high pH: which explains the possible onset of PU even in hypochloridria conditions. Helicobacter pylori (HP) has revolutionized the pathogenetic approach towards the gastric pathology: in 75% of cases there are alterations of the mucosae superficial profile, micropapillary changes, erosions, vacuolations with cellular degeneration. In 90% of cases is present chronic active inflammation in correspondence of the glandular neck of the gastric epithelium. In 70% of cases of BFGU there are qualitative alterations of the superficial epithelium. The gastric anatomic-functional behaviour, however, has an autonomous course and it is not influenced by the presence of infection. It results, therefore, that the bacterium is an important cofactor in PU pathogenesis by means of a direct cytotoxic-enzymatic action, without influencing a secretory behaviour which, in PU, is substantially conditioned by the genetic characteristics of the patient.